How is primary peritonitis treated?

Antibiotics are the mainstay of primary peritonitis, while secondary peritonitis is generally treated with surgery as soon as possible**, including removal of the primary lesion or repair of the perforation, and aspiration or drainage of intraperitoneal pus. For acute peritonitis that has been onset for more than 48 hours, if the abdominal pain is reduced, the tenderness is operated or the surgery is suspended, the patient should be temporarily fasted and decompressed, and receive antibiotics and fluids**.

For intra-abdominal inflammatory diseases that may cause peritonitis, appropriate early and appropriate ** should be carried out, which is the fundamental measure to prevent peritonitis. Any abdominal surgery, even including paracentesis, should be strictly aseptic. Before bowel surgery, oral antimicrobial drugs can reduce the occurrence of peritonitis.

Patients with cirrhosis, especially if hypoproteinosis develops, have a higher chance of peritonitis and can be treated with norfloxacin prophylactically.

Peritonitis is a very serious surgical disease, patients will have very severe abdominal pain symptoms, nausea, vomiting, fever and other symptoms, severe may appear toxic shock, once peritonitis is diagnosed, it is necessary to use a large dose of broad-spectrum effective antibiotics, which can kill the bacteria more effectively, of course, it also needs to be adjusted according to the results of bacterial culture, and sensitive antibiotics can be selected.

Peritonitis is mainly seen in the infection of the abdominal cavity or is the primary infection of the abdominal cavity, which requires timely selection of surgery, ** laparotomy to further clarify the primary lesion of the abdominal cavity, such as acute purulent appendicitis caused by the need to appendectomy, and at the same time, the water and electrolyte disorders should be corrected, and nutritional support should be given**.

Expert tip: once peritonitis is diagnosed, a large dose of broad-spectrum and effective antibiotics is needed to kill the bacteria more effectively, if there is a primary infection lesion in the abdominal cavity, it is necessary to choose surgery in time for laparotomy to further clarify the primary lesion of the abdominal cavity, such as acute purulent appendicitis, the appendix needs to be removed, and the water and electrolyte imbalance should also be corrected.

a.Abdominal puncture aspirates non-clotting blood.

b.Abdominal puncture to extract the mixed base turbid liquid with the debris of the split base.

c.Abdominal puncture to remove foul-smelling, dilute pus.

d.Abdominal puncture draws bloody fluid.

e.Abdominal puncture to draw out thin, odorless pus.

Correct answer: e

Categories: Healthcare.

Analysis: Peritonitis is an inflammation of the peritoneum and parietal peritoneum of the visceral layer of the abdominal cavity, which can be caused by bacterial, chemical, physical damage, etc. According to **, it can be divided into two categories: bacterial and non-bacterial; According to the clinical process, it can be divided into three categories: acute, subacute, and chronic, and according to the pathogenesis, it can be divided into two categories: primary and secondary. According to the extent of involvement, it can be divided into two categories: diffuse and limited.

**:1 Secondary Peritonitis Secondary purulent peritonitis is the most common form of peritonitis, perforation of abdominal organs, rupture of the abdominal wall or viscera due to injury, and is the most common cause of acute secondary purulent peritonitis. For example, in acute cholecystitis, the gallbladder wall is necrotic and perforated, resulting in extremely severe biliary peritonitis; Trauma causes rupture of the bowel, bladder, and bacteria enter the wound in the abdominal wall, which can quickly form peritonitis.

The second is the spread of inflammation of the abdominal organs, such as acute appendicitis, acute pancreatitis and other exudates containing bacteria that spread in the abdominal cavity and cause peritonitis. The bacteria that cause peritonitis are mainly the resident flora of the gastrointestinal tract, with E. coli being the most common. It is generally a mixed infection, so it is highly toxic.

2 Primary peritonitis, also known as spontaneous peritonitis, has no primary lesions in the abdominal cavity. **Mostly hemolytic streptococcus, pneumococcus pneumococcus, or Escherichia coli.

Main manifestations. 1 Abdominal pain is the most predominant clinical manifestation.

2. Nausea and vomiting.

3. An increase in body temperature and an increased pulse are related to the severity of inflammation.

4. Symptoms of infection and poisoning: high fever, pulse rate, shallow and rapid breathing, heavy sweating, and dry mouth.

**。1 Non-surgical**.

Non-surgical is feasible for patients with mild disease or disease duration of more than 24 hours, and abdominal symptoms have been reduced or have a tendency to reduce**.

Usually semi-recumbent position, fasting, gastrointestinal decompression, correction of electrolyte abnormalities, antibiotics, caloric and nutritional support, sedation, analgesia, oxygen.

2. Surgery**.

The vast majority of secondary peritonitis requires surgery**.

Mainly chemical drugs**.

Commonly used drugs are isoniazid, rifampicin, streptomycin, pyrazinyl, ethambutol, and amithiourea.

The following should be followed for the use of chemotherapy.

principle: early. Medication as soon as the diagnosis is confirmed;

Hyphenated. Combined application of 2 or more than 2 kinds of anti-tuberculosis drugs to ensure efficacy, prevent drug resistance, and reduce toxicity;

Amount. Law. Don't miss or interrupt.

Full. Generally, you need to take the drug for more than one year before you can stop the drug.

However, there are a few things to keep in mind:

1. The efficacy of anti-tuberculosis drugs on this disease is slightly lower than that of intestinal tuberculosis. Therefore, the medication and course of treatment should be intensified or appropriately extended. Generally, the combination of streptomycin, isoniazid and rifadine is preferred, and pyrazinamide or ethambutol can also be added, and after the disease is controlled, it can be changed to isoniazid and rifadin or isoniazid oral plus streptomycin twice a week, and the course of treatment should be more than 12 months.

2. For patients with ascites, after releasing ascites, drugs such as streptomycin and cortisone acetate are injected into the abdominal cavity once a week to accelerate the absorption of ascites and reduce adhesions.

3. For patients with hematogenous spread or severe tuberculosis toxemia, adrenal corticosteroids can also be added on the basis of the basal hail attack of effective anti-tuberculosis drugs** to reduce the symptoms of poisoning and prevent intestinal adhesion and intestinal obstruction.

4. In view of the fact that the disease is often secondary to other tuberculosis diseases in the body, and most patients have already received anti-tuberculosis drugs**, therefore, for such patients, drugs that have not been used in the past or are rarely used should be selected, and a combination drug regimen should be formulated.

5. In the case of intestinal obstruction, intestinal perforation, and purulent peritonitis, surgery can be performed. When it is difficult to distinguish from intra-abdominal tumors, exploratory laparotomy may be performed.